MISCELLANEOUS PHARYNGEAL DISORDERS 113
towards the external acoustic meatus, and in relation to the facial nerve,
which makes surgery difficult.
Ranula is a retention cyst and is found in the floor of the mouth. It causes a
feeling of fullness. If it arises in association with a mucous gland, simple
incision may cure it, but if it is associated with a salivary gland the cyst must
Foreign bodies frequently lodge in the pharynx, and are most often found in
the tonsil, the lingual tonsil at the base of the tongue or the palatine arches.
Fish bones are the usual objects to stick in the throat, but toothbrush bristles
may be seen. The foreign body causes pain and pricking, especially on
swallowing. These symptoms are not diagnostic of the object being still
present, because the scratching of the foreign body and the efforts to get rid of
it by the finger aggravate the symptoms even if they move the intruder.
Foreign bodies are not always easy to see on examination. A good light is
essential. If the bone projects from the tonsil or other part of the pharynx, it
may easily be seen, but if it lies flat on the surface of the tonsil, recognition is
less easy. Examination is made more difficult by the outpouring of saliva, and
an injection of atropine sulphate may be necessary to dry up the mouth.
Removal is fairly easy in a co-operative patient once the object is sighted, but
if the patient will not sit still, or if the foreign body cannot readily be identified,
a general anaesthetic-may be required, and inspection and palpation may have
to be employed. The most difficult cases are those in which the object sticks at
the base of the tongue, because it can only be removed in the outpatient
department in a co-operative patient who will hold out the tongue while the
surgeon searches for the object with a laryngeal mirror and removes it with a
suitable pair of forceps.
HAEMORRHAGE FROM THE PHARYNX
Although patients often seek advice because of spitting up blood which they
insist comes from the throat, true haemorrhage from the pharynx is un-
common. A search must be made in the throat for bleeding points, or for any
lesion, such as a malignant ulcer. The nose, nasopharynx and larynx must also
be examined, and the chest radiographed in the search for the cause. The
treatment is that of the cause, and if it is found to be a bleeding point in the
pharynx, this should be cauterized under local anaesthesia.
HYPERTROPHY OF THE LINGUAL TONSIL
The lingual tonsil is a mass of lymphoid tissue normally found on the dorsum
of the tongue between the vallate papillae in front and the epiglottis behind.
Hypertrophy may occur after tonsillectomy, or it may be found in women at
the menopause. If the swelling is large it causes the feeling of a lump in the
throat. Acute inflammation, or even abscess formation, may occur in the
lingual tonsil, and is seen with the help of a laryngeal mirror. Acute infections
are treated in the usual manner with antibiotics. Chronic enlargement may be